Individual
MARNIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
606 S ARROYO BLVD, PO BOX 529, RIO HONDO, TX 78583-4165
(956) 226-8389
(956) 630-6643
Mailing address
606 ARROYO BLVD, BOX 529, RIO HONDO, TX 78583-4165
(956) 226-8389
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
N0852
TX
207LP3000X
Pediatric Anesthesiology Physician
N0852
TX
208000000X
Pediatrics Physician
N0852
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
197710003
—
TX
05
—
197710005
—
TX
01
—
197710006
CSHCN
TX
01
—
8BX291
BCBS
TX
01
—
BP1-0018388
INSTITUTIONAL PERMIT
—
01
—
N0852
STATE LIC
TX
Enumeration date
05/26/2007
Last updated
11/22/2024
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